Basic Information
| Provider Information | |||||||||
| NPI: | 1407181571 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RENAL CARE CONSULTANT, P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 871337 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481876337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342338700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7300 N CANTON CENTER RD | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481871579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344548001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2009 | ||||||||
| LastUpdateDate: | 10/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | RAZA | ||||||||
| AuthorizedOfficialFirstName: | SHAZIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7342338700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 4301091041 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.